Perm Medical Journal

Current knowledge on sarcopenia in chronic kidney disease (CKD), with particular focus on unresolved issues in the diagnosis and management of sarcopenia is summarized.

An analytical review of recent publications on sarcopenia in CKD was conducted, covering prevalence, pathogenesis, diagnostic approaches, and treatment.  The analysis included reviews, meta-analyses, consensus documents, and original studies reflecting current approaches in nephrology and geriatrics, including data on sarcopenia in patients at predialysis stage, on dialysis, and after kidney transplantation.

 Sarcopenia is reported in 5–62 % of patients with CKD, with the highest prevalence observed in advanced stages and among those receiving renal replacement therapy. Pathogenetic mechanisms include uremic toxicity, chronic inflammation, hormonal imbalance, metabolic acidosis, and malnutrition. Diagnosis remains controversial: although EWGSOP2, AWGS, and FNIH provide stepwise approaches, no universal standard exists, which complicates cross-study comparisons and routine clinical implementation. Bioelectrical impedance analysis is widely used due to its accessibility and reproducibility; however, its accuracy may be compromised in patients with significant fluid imbalance. Therapeutic approaches are heterogeneous. Evidence supports the benefits of nutritional optimization, physical activity, and dietary supplementation. However, the optimal protein intake, the roles of vitamin D and omega-3 fatty acids, and the efficacy of emerging pharmacological therapies (myostatin inhibitors, hormonal agents) remain debated.

Sarcopenia in CKD is a major interdisciplinary issue with a strong impact on patient prognosis and quality of life. Early recognition and multimodal management can reduce disability and mortality risks. Nonetheless, further research is required to refine diagnostic criteria, standardize assessment tools, and establish effective preventive and therapeutic protocols.

Literature data from open sources (eLibrary, Scopus, Web of Science, PubMed) were analyzed and summarized with no limitations on search depth. The search was conducted using the following keywords: dorsopathy, inflammation, disc extrusion, disc herniation, discogenic radiculopathy, dorsopathy, disc inflammation.

Analysis of the obtained data suggests the formation of a new perspective on the problem of inflammation in the area of discogenic radiculopathy through the segregation of certain findings into isolated “paradoxes” or “vicious circles” of the described problem, thereby expanding the epistemological horizons of the pathogenesis of dorsopathies.

Aseptic inflammation in the intervertebral disc area is a multiphase process that includes preclinical biomechanical imbalance, the onset of dorsopathy, and the phase of extrusion formation and resolution. The development of inflammation is associated with the contact spread of immune and neuroinflammatory reactions to neural structures, along with simultaneous activation of reparative mechanisms. The proposed approach makes it possible to substantiate preventive and therapeutic strategies aimed at accelerating the resolution of the pathological process.

Objective. To evaluate the sex-related association between non-alcoholic fatty liver disease (NAFLD) and COVID-19 severity, and to assess the impact of metabolic syndrome components on the risk of severe disease.

Materials and methods. A retrospective analysis was conducted on 105 patients hospitalized with COVID-19 at the Bukhara Regional Infectious Diseases Hospital between September 2020 and September 2022. The diagnosis of non-alcoholic fatty liver disease (NAFLD) was established based on computed tomography (CT) or medical history. The study group included 55 patients with COVID-19 and NAFLD, while 50 patients with COVID-19 without NAFLD served as the control group. Multivariate logistic regression analysis was performed to evaluate predictors of severe COVID-19, adjusting for age, sex, body mass index (BMI), smoking, and components of metabolic syndrome.

Results. Severe COVID-19 occurred significantly more often in patients with NAFLD compared to those without NAFLD (34.5 vs. 18.0 %; p = 0.001). NAFLD and smoking were identified as the strongest independent predictors of severe disease. Women with NAFLD exhibited a higher risk of severe COVID-19 (odds ratio (OR) 4.17; 95 % CI 4.08–4.58; p = 0.001) compared to men (OR 3.18; 95 % CI 3.10–3.69; p = 0.004), whereas type 2 diabetes mellitus (T2DM) had minimal impact on this risk in women compared to men (OR 0.95; 95 % CI 0.84–1.09; p = 0.04). Obesity and metabolic syndrome were also independent predictors of severe disease in both sexes.

Conclusions. NAFLD is an independent risk factor for severe COVID-19 in both sexes, with a more pronounced risk in women. These findings underscore the importance of a comprehensive management approach for patients with COVID-19 that considers underlying NAFLD and metabolic abnormalities. Further large-scale prospective studies are needed to clarify the mechanisms underlying this association.

Objective. To study the prevalence of sarcopenic obesity in adolescents, to substantiate diagnostic criteria, and to identify possible predisposing factors and consequences.

Materials and methods. A standard clinical and laboratory study was conducted in 63 adolescents aged 12–17 years with obesity, including assessment of body composition, biochemical blood testing and hormonal profile analysis at the university clinic to identify sarcopenic obesity (SO). Statistical processing of the obtained results was performed using Microsoft Excel and Statistica. Relative risks and odds were calculated in Statistica at the ratio of outcome frequency among subjects exposed to a given factor to the frequency among those not exposed to that factor. 

Results. As a result, pathology was revealed in more than 50 % of the examined patients. Common bioimpedance criteria that can predict the development of sarcopenic obesity in adolescents were identified.  Common clinical and laboratory signs of SO and its consequences were also found, which may contribute to the diagnosis of this condition, as well.

Conclusions. The conducted study identified new diagnostic criteria for sarcopenic obesity in children, as well as patterns of pathology development, possible etiological causes and disease outcomes.

Objective. To determine early markers of developmental motor dysphasia. Neurodevelopmental disorders have various clinical manifestations, age of manifestation, and severity. One of the urgent tasks is to identify early predictors of deviant variants of children's development. Speech development disorder is observed in 3–7 % of observations in the pediatric population. Fundamental and early stages of neuropsychological development of the fetus and newborn are motor patterns and preverbal vocalizations.

Materials and methods. Of the 96 infants included in the study, a comprehensive dynamic examination was carried out on 28 children of low perinatal risk by the age of 3, of which two observation groups were formed. Group I (n = 16) – children without deviations in neurological status, psychomotor and speech development at the time of examination; Group II (n = 12) had developmental motor dysphasia by the age of 3 years during prospective observation.

Results. In children with the development of motor dysphasia, suboptimal qualitative parameters of generalized GMs in the distal parts of the hands were significantly more often revealed: hand-to-hand contact, manipulative, tracing movements in the period up to 5 months. A relationship was noted between the quality of manipulative and tracing movements, hand-to-hand contact with the amplitude and power parameters of vocalization. Violation of the formation of the spatial organization of hand movements in the first months of life is associated with the severity of expressive speech disorders at 3 years. The obtained results can be interpreted within the framework of the patterns of early ontogenesis of the nervous system. At the same time, the lateral (younger) corticospinal system regulates fine motor skills, is faster in relation to the executive function. Taking into account the somatotopic projections, manual skills are regulated from the inferior parietal and temporal regions of the cerebral cortex, which are anatomically adjacent to Broca's area (44, 45 Brodmann areas) of the posterior inferior part of the 3rd frontal gyrus.

Conclusions. Patterns of qualitative changes in fine motor skills during the period of key neurological transition may serve as early markers of the development of motor dysphasia.

Objective. Тo evaluate the feasibility, convenience, and effectiveness of diagnosing lung pathologies, including pneumonia, in children using a portable ultrasound system. The use of ultrasound in medical practice has become a landmark breakthrough, significantly improving the quality of care and increasing diagnostic accuracy. In terms of versatility and mobility, portable ultrasound systems with a set of transducers are particularly valuable, enabling high-quality imaging regardless of the patient’s location, while being substantially smaller and lighter.

Materials and methods. A comparative study was conducted at the Perm Regional Children's Clinical Hospital. We diagnosed lung diseases, including pneumonia, in children using the Mindray DC 6 and Logic S 8 ultrasound systems, as well as the ELS-MED^ТМ ultrasound diagnostic system with a portable transducer (using linear and convex transducers). We compared their diagnostic capabilities, operational features, and the results obtained during the study.

Results. The studies showed that 8 children (53.3 %) had interstitial lung changes, 3 children (20 %) had pneumonia, 1 child (6.7 %) had chest masses, and 3 children (20 %) had no pathology. In all 3 children (20 %), lung tissue consolidation was detected in 2 segments, with bilateral lung involvement. Bilateral interstitial changes were found in 8 patients (53.3 %). In one patient with lung consolidation, pneumonia was combined with interstitial changes. Fragment-type lung consolidation was found in 2 children, and consolidation with air bronchogram elements was found in 1 person. No differences were observed in the visualization of lung consolidation areas or interstitial changes between the stationary and portable transducers. The sizes of the lung consolidation areas were practically the same when measured. Interstitial changes were clearly visible on both devices. In the study group, one child had chest masses. The portable device also allows clear visualization of the masses, assessment of blood flow, and visualization of the soft-tissue component in the muscle and connective tissue layers, similar to a stationary ultrasound machine.   

Conclusions. Portable ultrasound devices can be used to diagnose pneumonia, interstitial lung changes, and even tumours in children. We observed no significant differences between the use of stationary and portable ultrasound devices.

Objective. To study the impact of regular physical exercise on the dynamics of systemic metabolic inflammation biomarkers, body composition indices, muscle mass, and vascular elasticity parameters in patients with arterial hypertension who recovered from COVID-19.

Materials and methods. This single-center prospective interventional study included 74 patients with hypertension 3 months after recovering from COVID-19. The study group (n = 37) performed an adapted exercise therapy program (3 gym sessions and 4 home workouts per week) for 9 months in addition to standard recommendations; the control group (n = 37) received only standard recommendations. The following parameters were assessed at baseline and after 9 months: inflammatory markers (IL-1b, IL-6, IL-10, TNF-a, CRP), lipid profile, glycemic control (HbA1c, TyG, CTI, TyG-WHtR), metabolic indices of body structure, muscle strength parameters (deadlift strength), body composition (bioelectrical impedance analysis), 24-hour blood pressure monitoring (ABPM) parameters, and pulse wave velocity (PWV).

Results. In the exercise therapy group, a significant decrease in proinflammatory cytokines IL-1b by 28.7 % (p = 0.028) and TNF-a by 31.2 % (p = 0.011) was recorded, with an increase in anti-inflammatory IL-10 by 20.0 % (p = 0.001); HbA1c decreased to 5.38 % (p = 0.010), TyG-WHtR by 10.7 % (p = 0.003). A decrease in waist circumference by 9.4 cm (p = 0.001), BMI by 2.7 kg/m² (p = 0.001), and waist-to-hip ratio (WHR) (p = 0.020) was revealed; deadlift strength increased by 16.3 % (p = 0.002) with a decrease in absolute fat mass by 4.36 kg (p = 0.001) according to bioelectrical impedance analysis. According to ABPM, in the exercise therapy group there was a decrease in the diastolic blood pressure (DBP) variability (p = 0.021), the rate-pressure product (p = 0.050) and night HR (p = 0.034) compared to the control. The PWV indicator decreased by 11 %, but did not reach the target values.

Conclusions. A long-term regular physical training program in patients with hypertension in the post-COVID period improves structural and functional parameters of the body and muscle function, while reducing markers of metabolic inflammation, improving hemodynamic parameters, and improving vascular elasticity. These data support the inclusion of moderate-intensity physical training in the treatment and prevention program for this patient population.

Objective. To study the effect of mineral water of Klyuchi Resort therapeutic and table mineral water on the intestinal microbiome of white mice with experimental dysbiosis. We have previously demonstrated the bacteriotropic effect of this mineral water on the obligate intestinal microbiota in vitro. The present study investigated the effect of this mineral water on the correction of experimental dysbiosis in laboratory animals.

Materials and methods. Experiments were performed on 42 outbred male white mice. Dysbiosis was induced by oral administration of a gentamicin solution for 8 days. The test group of animals received mineral water, while the control group received boiled tap water. The qualitative and quantitative composition of the animals' intestinal microbiota was assessed dynamically using a classical bacteriological method. Reference points were baseline values before antibiotic administration, after the antibiotic course, and on the 14th and 28th days of mineral water intake.

Results. Dysbiosis was characterized primarily by a significant decrease in the titers of Lactobacillus and Bifidobacterium species and the appearance of Klebsiella and Proteus in high concentrations. After two weeks of mineral water administration, the test group showed a tendency toward normalization of the intestinal microbiota composition. These positive changes increased over time. After 28 days, lactobacilli count in the test group of animals returned to initial values. Klebsiella spp. and Proteus spp. were not detected.

Conclusions. Mineral water of Klyuchi Resort contributed to the normalization of the qualitative and quantitative composition of the intestinal microbiota in laboratory animals with experimental dysbiosis.

This article is dedicated to Professor Pavel Ivanovich Pichugin—an outstanding pediatrician, scientist, educator, public figure, head of the Department of Pediatric Diseases, and founder of the first Children's Clinic in the Western Urals, which later became the only clinical institution training pediatricians. Over time, new archival facts become available, key events are being reinterpreted, and our understanding of them is changing. A professional interest arises in assessing the contribution of each person involved in the establishment of pediatrics in the Western Urals. The historical materials presented allow us to trace Pavel Ivanovich's development as an individual, a researcher, and a practicing physician, and to evaluate the role of his mentors, who not only helped him choose his field of activity but also contributed to the development of his scientific potential and instilled in him a love of the profession.

This article explores the life of the renowned Russian surgeon Vyacheslav Mikhailovich Subbotin (1940–2025). He graduated from the Perm Medical Institute and then completed postgraduate studies at the Moscow Research Institute of Clinical and Experimental Surgery. In 1969, he defended his PhD dissertation in Moscow on "Anatomical, Experimental, and Clinical Materials on Tracheal Surgery." He worked at Ye.A. Vagner Perm State Medical University from 1970 to 2021, rising from an associate professor in the Department of Hospital Surgery to the head of the Department of Faculty Surgery with a course in urology. In 1993, he brilliantly defended his doctoral dissertation on "Operative Thoracoscopy" and was promoted to full professor in 1994. V.M. Subbotin was a renowned Russian surgeon and a distinguished specialist in thoracic and minimally invasive surgery, performing complex operations on the esophagus, lungs, trachea, pleura, heart, liver, gastrointestinal tract, and other organs. V.M. Subbotin pioneered the method of operative thoracoscopy in Russia and a number of surgical techniques on the esophagus and tracheobronchial tree. He authored 276 scientific publications and 13 inventions, and successfully presented at international scientific conferences in Louisville, Tokyo, and Prague. During his lifetime, he performed over 5,000 operations and trained 5,000 students and physicians.